The proposed research will assess the relationship of nurse accountability to patient outcomes as well as the role of other variables in the achievement of patient outcomes that are sensitive to nursing care. These data are needed to best structure and manage the delivery of quality nursing of patients in a cost constrained environment. Research in the relationship of perceived professional nurse accountability and patient outcomes is important to assessing how nursing care impacts patient outcomes, and is required to meet the profession's mandate, to influence health policy, and to challenge nursing to measure and quantify its positive impact on quality of care. Specific aims are to describe: 1) the perceived accountability of nurses working in primary nursing, team nursing, total patient care, and case management care systems on hospital orthopedic units, 2) the relationship of nurses' perceived accountability, job satisfaction, work environment, and achieved patient outcomes, and 3) the unique contribution of nurse accountability and type of delivery system to achieved patient outcomes in addition to the contribution of nurse and patient demographics, perceived job satisfaction and work environment.